When the Wisconsin Medicaid managed care program was expanded to include members who had traditionally opted out of the program, the HMOs that were going to serve these members had to optimize their member engagement strategies.
Independent Care Plan (iCare), one of the HMOs selected as a Medicaid plan, identified early member engagement after enrollment as a key to success for the program.
Telephonic and Community-Based Care Coordination Model: An Early Engagement Approach for Medicaid Managed Care outlines how iCare has structured its care coordination team, including both telephonic and boots on the ground staff to find, engage and assess Medicaid members.
In this 25-page resource, Lisa Holden, vice president of accountable care, iCare, shares the key elements of its care coordination model that has allowed it to achieve a 90 percent health risk assessment completion rate within 60 days of enrollment.
Ms. Holden covers the following topics in this report:
- The timing of iCare’s early engagement effort by its telephonic care coordinators and the goal for this initial contact;
- A 13-point protocol for care coordinators to locate hard-to-find Medicaid managed care members and details on how iCare holds the care coordinators accountable for this protocol;
- The role of health coaches within the community in helping to locate Medicaid managed care members and connecting them with needed social support services;
- How the care coordinators help Medicaid members overcome barriers to care;
- Seven rising risk/acuity identification tools;
- Readmission prevention initiatives for high-risk patients;
- Three programs aimed at reducing high emergency department utilization;
- Details on a Follow-to-Home program for members who are homeless;
- and much, much more.
1. Medicaid Member Engagement: A Telephonic Care Coordination Relationship-Building Strategy
Early Engagement After Enrollment
Difficult to Contact Resources List
Core Elements of our Care Coordination model
Overview of Care Coordination
Social Health Determinants
Overcoming Barriers to Care
Rising Risk/Acuity Identification Tools
High ED Utilization
Inpatient Reduction Components
Inpatient Psychiatric Stays and Readmits
Chronic Disease Management Program
Primary Care Assignment
Follow to Home for Homeless
Wellness Clubs and Community Health Fairs
2. Q&A: Ask the Expert
Potential Specialists To Add To Care Team
Language To Avoid When Engaging Medicaid Members
Incentives for Engagement and Activation
Best Times of Day, Time of Month To Contact Medicaid Members
Assessing for Readmission Risk
Skill Sets and Background of Care Coordinators and Health Coaches
4. For More Information
5. About the Contributor